Inspection on 13/10/08 for Prudential Care Home Ltd

This inspection was carried out on 13th October 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Prudential Care Home Ltd 16/10/06

Prudential Care Home Ltd 27/02/06

Prudential Care Home Ltd 01/08/05

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Prudential Care Home Ltd 7a Grant Terrace Castlewood Road London N16 6DS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nurcan Culleton     Date: 1 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Prudential Care Home Ltd 7a Grant Terrace Castlewood Road London N16 6DS 02082111957 02082117406 prudentialcarehome@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr John Gerard Kearns Type of registration: Number of places registered: Prudential Care Home Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 7a Grant Terrace is a three storey end of terrace building situated in a quiet residential area with good access to public transport near Manor House station. The home has easy access to a wide range of local facilities and amenities. The home is registered to accommodate four adults and is suitable for individuals with forensic psychiatric histories. The home offers 24 hour support with a trained psychiatric nurse on site. Staff at the home support residents to regain and retain independent living skills that will enable them to move into supported accommodation. All referrals to the home are Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 4 Brief description of the care home as a result of Care Programme Approach meetings and the home does not accept emergency referrals. The home offers both short-term and long-term placements. Fees are currently £850-£1000 per week and vary according to assessed needs. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place over one day. The deputy manager assisted and another staff member assisted us as the registered manager was away on leave. We examined the quality standards being achieved by the home and the extent to which the home complied with requirements made at the previous inspection in 2006. We spoke with people living in the home and with staff; we examined care plans, risk assessments, daily records, minutes of meetings and the homes policies and procedures. Four people are resident in the home and two were present in the home at the time of inspection. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have freedom of movement and exercise choice in their daily activities. Staff work in a way that is enabling, encouraging and supportive, providing people with opportunities to improve their mental state, thereby allowing them to grow in confidence and independence. Evidence: Staff were knowledgeable about the admissions process and we viewed how this operates in sampled files. Referral forms to the service were available. Information forms contained key contact details and assessments by referring health and social service authorities. The care coordinator of the placing authority completes assessments prior to admission. The home completes its own inhouse full needs assessments at the point of referral and decides if the home is suitable. The assessment process continues throughout the persons first six weeks of stay. Multi-disciplinary professionals, relatives and the individual are involved in the final decision about the placement in a Care Programme Care Homes for Adults (18-65 years) Page 9 of 32 Evidence: Approach meeting. The homes in house assessments were viewed and considered to be very comprehensive, outlining the prospective users needs identifying any cultural, language, religious needs and their sexuality. Staff were able to describe the particular religious needs and preferences of individuals in the home and how this reflects in the way staff support individuals with these choices in their daily lives and activities. Staff informed about how they were encouraging one person for whom English is not their first language, to develop their English language through buying a dual language newspaper. There are staff members in the home who are also able to speak this individuals language. People can visit the home to decide if is is suitable for them, then stay for a trial period and an overnight stay. Individuals are orientated to the local area and amenties during their trial stay. All those currently living in the home have been through this process. A statement of terms and conditions of occupancy was available in each persons file. It is positively noted that individuals are given a Resident Handbook, which includes a residents charter, philosophy of care and guideline on the complaint procedure. The Statement of Purpose defines well the homes aims and objectives and person centred approach to the service. It is recommended that the new contact details for CSCI in the Statement of Purpose and Service Users Guide are updated and that these documents are available in larger print or alternative formats to suit individual needs. Care Homes for Adults (18-65 years) Page 10 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Persons in the home are provided with a theraputic and stable environment where they have opportunities to progress and develop. Comprehensive support plans and risk assessments which identify their needs and are used to maximise the benefits of the service and to enhance the support given to each individual in their placement. Evidence: The staff member we interviewed had good knowledge and understanding of the needs of each individual demonstrated how she was able to use the homes policies and procedures to assist in her working effectively with individuals in the home. She described the importance of becoming familiar with the individuals care plan, getting to know the individual through observation, interactions and key working sessions. Key workers write the individuals care plan and risk assessments. A CPA meeting is arranged by the care coordinator including other professionals involved with timing dependent on whether the person is newly admitted or their CPA level. This may be a Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: three month, six month or annual meeting. We examined three out of four files, all containing detailed care plans and risk assessments, both from the referring authorities and the Support Plans completed by the home. One NHS CPA Care plan and Risk Management Plan, for example, included contingency and crisis planning, identifying early warning signs. The homes Support Plans were each signed by the individuals and their key worker and their needs identified and separately reviewed. These plans included comprehensively identified goal planning and interventions that demonstrated a good understanding of each persons needs. Whilst the Plans stated that these needs were to be reviewed monthly, in practice, the care plan needs were being reviewed every month to three months. It is recommended that Support Plans are reviewed monthly in line with the homes policy. Despite this, it is clear that individuals needs are being closely monitored in an additional measurement tool known as HONAS, Health of the Nation Outcomes Scales. This tool is used from the point of admission from to measure the individuals mental health, giving them a score of between 0-4. An explanatory sheet is used to assist with this and is completed by the manager or senior staff. This is a tool which makes it easier to see someones progress and mental state at first glance. Overall scores are reviewed monthly and used to assist the review of the Support Plan. Staff informed that most of the clients have forensic histories and that people have made alot of progress through a de-escalation method used by staff and their theraputic relationships in the home. The theoretical underpinning to this approach was explained to us.The progress of individuals in the home was also described, some having made significant progress and was evident in minutes of individuals reviews, observation records, their risk assessments and quality assurance surveys. One persons risk assessment stated that there had been much improvement in their mental state and wellbeing such that they were no longer considered to be a risk to themselves or others. We were informed that, since their admission, none of the residents in the home have relapsed here and that all had unsuccessful placements prior this one. This success was attributed to staffs understanding of the individuals, their philosophy underpinning how they work and working flexibly to fit in with individuals lifestyles and their mental state. Evidence was available in minutes of meetings and throughout their files that individuals are consulted about matters important to and affecting them and that the service is tailored to meet their needs. Regular key worker meetings were available in each file, signed by both the individual and key worker and full agenda Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: items noted. In-house risk assessments state identified risks to individuals, including health and safety in the home, includes level of risk and control measures. However the level of risk, and control measures to minimise risks do not apply to personal risks, including mental health, personal care and safety and it is recommended that these too are included. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have freedom of movement and exercise choice in their daily activities. Staff work in a way that is enabling, encouraging and supportive, providing people with opportunities to improve their mental state, thereby allowing them to grow in confidence and independence. Evidence: Individuals are encouraged to participate in day to day running which include cooking, laundry, cleaning of their environment and decision making in regards to activities. Staff described the various areas where individuals were independent and areas where they needed support and encouragement. Two people we spoke with said they very much liked the home. One person said that the service was excellent. Staff had helped him to become more independent; that he could now cook when he couldnt before; he was more patient, sociable and his mental health had improved. He said that staff Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: were always there for him, helping him to help himself. No one is currently engaged in employment or continued education, though these opportunities are available to people and staff would offer support and encouragement to individuals willing or able to participate in these activities. Some individuals are encouraged to attend the local MIND day centre and access local facilities including the gym, cinema, church and the shops. A computer is available for residents to use in the house if wish, however we were informed residents very rarely use it. Residents had requested Sky to watch football and this has been bought for them. Activities are tailored to the individual based on their choice. Evidence of events and activities were detailed in records for each person in the home. Residents have been out to Brighton for a weekend holiday as chosen by them. Throughout the course of the inspection we observed that individuals had choice in their movements in the home, their interactions with staff and their daily activities. Staff were observed to treat individuals with respect and a positive and relaxed atmosphere was apparent in the home. We saw a daily diary of lunch and evening meals, plus a separate folder that evidenced weekly consultation with people regarding their preferred meals which they sign. Individuals are also encouraged to write their comments as to whether they like the meals theyve eaten. Recorded views showed how people enjoyed their meals. We were informed that people choose to have a take away for an evening meal one night a week, where they often have other ethnic meals. Staff informed that people in the home liked rice and curry and records of these meals were seen, reflecting individuals chosen meals and the cultural and individual preferences of each person. Foods stored in the fridges were appropriately labelled. Daily routines of the home promote choice and independence. Letters addressed to individuals are opened by them. All have keys to the front door and to their rooms. Residents are all registered on the electoral roll and are encouraged to vote, though we were informed they chose not to do so. The staff on duty stated that visitors are welcomed into the home and records seen and individuals we spoke with confirmed that contact with their family and friends is encouraged. We noted also that the home takes positive action when faced with the need to balance individuals contact with family members or friends in the home in situations where this contact may have a possible detrimental impact on others. We found that the home manages well this particular type of situation, ensuring that Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: significant contacts are maintained whilst at the same time safeguarding the best interests of other individuals in the home. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and support is delivered in a way that is suitable and beneficial to each individual. The home promotes individuals physical and mental wellbeing. Policies and procedures are in place for management and safe handling of medications. Evidence: Individuals ability to exercise choice in their daily activities are described in the section above. Staff work flexibily to support people by fitting in to their activities and chosen daily routines, for example, working with people when they are more receptive to support and at times when they choose to be available in the house, any time during the day or at night. Additionally, the service has good links with health professionals with whom they work in partnership to improve the physical and mental health wellbeing of individuals living in the home. Files contained comprehensive records of contact with health professionals, showing the individual or homes contact with community psychiatric nurses, psychiatrists, occupational therapists and care managers. There was evident available that the home actively seeks out ways to become better informed about individuals needs, such as files containing copies of information fact sheets downloaded from the internet headed, What I need to know Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: about... with reference to particular health conditions. All individuals are registered with the local general practitioner and are encouraged to attend regular check-ups. At the time of inspection, one individual was visiting his GP to have an annual check up. Evidence was seen of dentist and opticians appointments on files. Staff support individuals to attend appointments with other professionals involved in their care if this support is required. There is an organisational policy and procedure, which covers all aspects of medication handling and administration. Staff spoken to were knowledgeable about correct medication practices. All staff have received medication training. Medications were appropriately stored in individual locked cupboards in the office and records relating to all aspects of medication handling were well kept with adequate auditing practise in place. Medications available corresponded with those listed on the Medication Administration Record sheet. Staff prompt and support people to take their medication. We were informed that this has been a major contributory factor to the success of each individuals placement, as staff assist to stabilise and maintain the mental health of each person by ensuring they take their medication regularly, thus allowing staff to work theraputically with them. One individual was assessed by a district nurse as being competent to self-administer their medication and records, including their Support Plan, were available to confirm this. Whilst the individuals Controlled Drugs medicine is stored in a cupboard in his room, it is recommended to ensure that the cabinet is compliant with regulations for Controlled Drugs cabinets and to ensure that the home has a Controlled Drugs cabinet suitable for storage of any other Controlled Drugs which may come into the home in the future. The home has a policy of not using homely remedies. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns or complaints are listened to and are minimised as they are promptly dealt with to ensure that individuals are satisfied with their service. Appropriate procedures are in place to deal with adult protection and staff are trained and knowledgeable in relation to these. Evidence: Individuals spoken to know how to complain, have no complaints at present and informed that staff are approachable and their views and concerns are listened to and dealt with promptly and appropriately. A clear complaints procedure is in place which includes details of the responsible individual and the Commission should individuals wish to raise their concerns elsewhere. We viewed the homes complaints log and noted that there had been one complaint recorded since the last inspection. Details of this complaint was recorded, the complaint investigation and its outcome noted. This was signed by manager. The homes adult protection procedure was found to be satisfactorily written. This includes definitions of the different types of abuse that individuals can experience and makes appropriate reference to adult protection guidelines for staff to follow should they have any adult protection concerns. A separate whistle blowing policy. All members of staff have been trained in-house and assessed in regards to adult protection issue. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: We were informed that all individuals have their own bank accounts and are independent in managing their own money, however staff assit them to budget. Individuals keep their own bank cards or giros and spend their money as they wish. Evidence was seen of money and budgetting issues being discussed in records of individual key worker meetings. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is maintained to a high standard that is pleasant, homely, comfortable and personalised to suit the needs of people living in the home. Evidence: The home continues to provide good standard accommodation which includes private bedrooms and spacious communal areas. The home is situated within walking of Stamford Hill High Road providing convenient access to many shops and other amenities. We were satisfied that the premises are generally suitable for the stated purpose. One persons bedroom was inspected and was of adequate size with sufficient light, heat and ventilation. The room looked personalised and contained facilities required in line with standards. However it was observed that the windows in this room opened out wide which could present a safety risk to the individual in the room. for reasons of health and safety it is recommended that window restrictors are installed in all rooms where a safety risk could be identified, pending a health and safety risk assessment. Suitable chairs have been bought for those individuals who have requested them in their bedrooms, as required at the last inspection. Comfortable chairs have also been purchased in the lounge. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: It was positive to note that service users had extra facilities such as fridges in their bedrooms. There are sufficient washing and bathroom facilities in the home. The kitchen was clean and well kept. In the kitchen we observed that some opened jars were labelled and some were not. It is recommended that all opened jars are labelled. The living environment was observed to be homely, clean, comfortable and generally well maintained. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals in the home benefit from the support they receive from a staff group who have a good understanding of their social, mental health and care needs of people. Stafff receive adequate supervision and training to support them. Evidence: Staff we spoke with were clear about their roles and responsibilities and the positive outcomes demonstrated by people living in the home evidenced the extent to which they benefit from the theraputic relationship with staff. We interviewed one staff member who confirmed that they had relevant previous experience, that they received induction when they started and regular supervision, approximately every six weeks. They had received a job description and contract and informed that they received a broad range of training. Training included POVA, health and safety such as manual handling, food safety and challenging behaviour. Training needs are identified for each staff member. Records were seen were the majority of staff had undertaken refresher training. This training included risk assessments, first aid, the role of carer, raising concerns and whistleblowing, POVA, principles of person centred care, medication and managing challenging behaviour. A staff member informed us that with the refresher course, all staff expected to look at videos, seen stored in the office, and to complete questionnaires after they complete the course to test their knowledge and skills. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The majority of the staff have NVQ Level 2, exceeding the 50 minimum standard and new staff have been recruited who will be starting their NVQ Level 2. There are also Registered Mental Nurses, which includes the registered manager and Registered General nurses in the home. Individuals in the home thus benefit from the support they receive from a staff group who have a good understanding of the social, mental health and care needs of people living in the home. The duty rota was seen and was accurate on the day of inspection. We were informed that there are permanent staff and permanent bank staff, including one support worker and one manager on duty, who may be a manager or senior support worker. There is one wake-in staff member and 24 hour manager on call. The deputy manager informed that additional staff are booked if escorts are required or additional activities. Minutes of staff meetings showed that these meetings take place on a regular basis, covering issues such as training, policies and organisational issues discussed during these meetings. Staff employment records were in order and appropriate documents were available in all sampled staff files, including identification, Criminal Record Bureau Checks, application forms and explanatory records regarding gaps in employment histories. It is however recommended that the POVA check dates are recorded if staff start work prior to their full CRB being received. It is also recommended that a health check clearance is available for all staff, regarding their mental and physical health. This may be a self declaration. A supervision book was examined, logging dates of supervision undertaken and signed by the supervisor and supervisee, recorded as taking place for one hour each session. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well managed home that is led by an experienced manager. People can expect have good to excellent outcomes in this service provision. Evidence: The registered manager has extensive experience in management and was thought of by staff to be competent, approachable and supportive, offering constructive critisicm to staff when they need it. It is clear that the managers leadership and direction is clearly communicated to staff and ensures that the aims and objectives of the home are effectively and consistently achieved. Quality assurance surveys have recently been sent out to people in the home, their families, staff and other professionals, according to the deputy manager. Existing surveys seen included a range of positive comments. These include: One person living in the home stated that they were , Extremely happy but more time in Prudential will improve me and things in life. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Its great here I tell you, I really like it here, Im well looked after by the staff, its the best place here. We can do whatever we want, the staff are very supportive. Its the best place Ive ever been and I really enjoy it here. Relatives were very complimentary about the home. The following are quotes taken from a number of sampled survey dated 30.03.08: My son ...is more settled. The staffs are very kind and helpful and I can phone them anytime if I am concerned or worried about anything... I am more than happy with my sons progress. Its been years since he looked so well .. before he became mentally ill. We owe everything to prudential; their patience has been unlimited along with their great dedication and love has all conributed in .. great return to a normal like and hes well on the road for a great future. We..always find staff courteous and amenable. Very accommodating and family arrangements are always available to discuss potential problems. ...Has made excellent progress at Prudential, more than I ever expected. One complaint is that there isnt the chance to comment on excellence referring to the tick box quality standards in the surveys. These comments demonstrate that the service is seen as a valuable resource which has, in some cases, made a profound difference in some peoples lives and is reflected throughout the homes monitoring of the progress of individuals. Ten professionals surveys were all, equally complimentary. Their comments include: We have been impressed with the level of care afforded to our client living in your accommodation ...Succeeded in helping a very hard to engage client to settle in to what he now views as his home. I have been impressed with the high standards of accommodation. Overall the service has been excellent and Grant Terrace has provided .. with a stable and supportive environment. Very high standard of provision. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Sterling example of care provision in a physically and psychologically safe environment. Recommendations are given as follows... to ensure all surveys are dated; to have the option of ticking excellent in the quality assurance surveys when commenting about the service and for the service to produce an annual development plan taking into account any views of those involved in the surveys. Policies and procedures were available and in line with National Standards. The homes records are in good order and significant events were seen recorded in each persons file. Health and safety practices are well observed. A COSSH cupboard is locked in the kitchen. Staff are responsible for making health and safety checks and for keeping accurate records. Current Health ad safety certificates were available apon request. The recommendation to install window restrictors as referred to earlier is made under the standard of Health and Safety of this outcome group. Monthly monitoring visits take place and reports produced. The last report available was in September 2008. A public liability insurance certificate was on display in the office. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 17 13. (1)(c) The responsible person must 29/12/2006 ensure that out of date food is discarded. The responsible person must 29/12/2006 ensure that comfortable chairs are provided in service users bedrooms. The responsible person must 31/01/2007 ensure that at least 50 of the work force has undertaken NVQ qualification in care. The responsible person must 29/12/2006 ensure that appropriate references are obtained from previous employers before staff commences employment. The responsible person must 31/01/2007 that the home: Develop a quality assurance and monitoring system. Develops a business plan. The responsible person must 31/01/2007 ensure that a qualified electrician should only carry out the testing of all portable appliances. 2 26 16. (2)(C) 3 32 18. (1)(a)(c) 4 34 19(1)(c) 5 39 24 6 42 23(2)(c) Care Homes for Adults (18-65 years) Page 28 of 32 7 43 26 The responsible person must 31/03/2007 ensure that monthly visits are conducted and reports are made available for inspection. Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that the new contact details for CSCI in the Statement of Purpose and Service Users Guide are updated and that these documents are available in larger print or alternative formats to suit individual needs. It is recommended that the level of risk and control measures to minimise risks also apply to personal risks, including mental health, personal care and safety. It is recommended to ensure that the cabinet is compliant with regulations for Controlled Drugs cabinets and to ensure that the home has a Controlled Drugs cabinet suitable for storage of any other Controlled Drugs which may come into the home in the future. It is recommended that POVA check dates are recorded if staff start work prior to their full CRB being received. It is also recommended that a health check clearance is available for all staff, regarding their mental and physical health. This may be a self declaration. 2 9 3 20 4 34 5 39 It is recommended to have the option of ticking excellent in the quality assurance surveys. The service to produce an annual development plan that includes the overall outcome of the surveys, taking into Care Homes for Adults (18-65 years) Page 30 of 32 account any views of those involved in the surveys. 6 42 It is recommended that window restrictors are installed in the windows of all rooms where a safety risk could be identified to the resident, pending a health and safety risk assessment. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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